Zrour-Hassen Saoussen, Jguirim Mahbouba, Guezguez Mohsen, Mnif Hichem, Younes Mohamed, Bejia Ismail, Touzi Mongi, Abid Abderrazek, Essabah Habbib, Bergaoui Naceur
Universite de Monastir, Tunisie.
Tunis Med. 2011 Feb;89(2):136-41.
The fracture risk assessment tool (FRAXTM), published in February 2008, is developed based on the use of clinical risk factors with or without bone mineral density tests.
To calculate the FRAX tool in a cohort of Tunisian patients in whom bone mineral density (BMD) was assessed by dual X ray absorptiometry (DXA); to correlate this score to osteoporotic fracture and to BMD assessment and to propose a threshold for therapeutic intervention.
In a cross sectional study of 582 patients older than 40 years, in whom a BMD measurement by DXA has been performed between January 2006 and December 2009, clinical risk factor for osteoporotic fracture and the occurrence of a prior fragility fracture were assessed. The French version of the FRAX tool was used. Threshold for pharmacological intervention was evaluated by ROC curve.
Patients were aged 62.3 ± 10.4 years. They were female in 91.2% of cases. BMD measurement was under 2.5 standard deviation in 53.2%. Osteopenia was noted in 29.2% of cases and BMD was normal in 17.4 % of cases. Osteoporotic fractures were observed in 38.2% of cases. Major osteoporotic fractures (FOM) (hip, vertebra, radius occurred in 82% of cases. The FRAX® score calculated with T-score was 8.55 ± 8.54% for the FOM and 3.02 ± 6.37% for femoral neck (FN), while it was 7.81 ± 6.45% for the FOM and 2.58 ± 3.97% for the FN if calculated without T-score with a significant difference (p <10-3). For the patients having T-score under 2.5 SD, FRAX score was 11.39 ± 10.32% for the FOM and 4.74 ± 8.13% for the FN if calculated with T-score and it was 9.18 ± 6.95 % for the FOM and 3.19 ± 4.11 % if calculated without T-score. The score FRAX was correlated to BMD (r=0,53, p <10-3) and to fracture prevalence (p < 10-3). The threshold of therapeutic intervention was fixed to 30% for the FOM and 7% for the FN.
Our study confirms the usefulness of the FRAX score in the prediction of fracture risk in Tunisian population. The determination of therapeutic threshold intervention requires other prospective and larger studies with medico-economic analyses.
2008年2月发布的骨折风险评估工具（FRAXTM）是基于使用临床风险因素（无论是否进行骨密度测试）而开发的。
在一组通过双能X线吸收法（DXA）评估骨密度（BMD）的突尼斯患者中计算FRAX工具；将该评分与骨质疏松性骨折以及BMD评估相关联，并提出治疗干预阈值。
在一项对582名40岁以上患者的横断面研究中，评估了2006年1月至2009年12月期间通过DXA进行BMD测量的患者骨质疏松性骨折的临床风险因素以及既往脆性骨折的发生情况。使用FRAX工具的法语版本。通过ROC曲线评估药物干预阈值。
患者年龄为62.3±10.4岁。91.2%的病例为女性。53.2%的BMD测量值低于2.5个标准差。29.2%的病例为骨量减少，17.4%的病例BMD正常。38.2%的病例观察到骨质疏松性骨折。主要骨质疏松性骨折（FOM）（髋部、脊椎、桡骨）占82%。用T值计算的FRAX®评分，FOM为8.55±8.54%，股骨颈（FN）为3.02±6.37%；若不使用T值计算，FOM为7.81±6.45%，FN为2.58±3.97%，差异有统计学意义（p<10-3）。对于T值低于2.5 SD的患者，用T值计算时，FOM的FRAX评分为11.39±10.32%，FN为4.74±8.13%；不使用T值计算时，FOM为9.18±6.95%，FN为3.19±4.11%。FRAX评分与BMD相关（r=0.53，p<10-3），与骨折患病率相关（p<10-3）。治疗干预阈值确定为FOM为%，FN为7%。
我们的研究证实了FRAX评分在预测突尼斯人群骨折风险中的有用性。治疗阈值干预的确定需要其他前瞻性、更大规模且带有医学经济学分析的研究。
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